Towards a New World of Externships: Introduction to Papers from Externships 4 and 5

The scholarly literature on externships is growing and deepening, addressing concerns of importance to field placement programs and to clinicians in general. This Introduction places the issues raised by the subsequent four articles on externships into the context of current national debates about the externship method. These issues, which both extend and diverge from current thinking about externship pedagogy, include: 1) the impact of a harsh economic climate; 2) the educational potential of placements in corporate counsel offices; 3) the argument for compensating students in for-credit placements; and 4) the value of course design for teaching power dynamics in supervisory relationships. Taken together, the issues explored in these four articles point toward a new world of externships, filled with both opportunity and risk for clinical education. This new world poses key questions, not just for externships, but for clinical legal education and legal education generally

Stress and coping patterns of participants and non-participants in self-help groups for parents of the mentally ill

The authors examined differences in stress and coping patterns as well as in situationally-related variables between participants and non-participants in self-help groups for parents of the mentally ill in Israel. Participants, who were higher on socio-economic status indicators, reported coping patterns that tended to be both more active and interactive. They also reported greater concerns around psycho-social issues than non-participants. The authors discuss the possible interrelationships among these findings.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44305/1/10597_2004_Article_BF00752453.pd

Effect of praziquantel treatment of Schistosoma mansoni during pregnancy on intensity of infection and antibody responses to schistosome antigens: results of a randomised, placebo-controlled trial

BACKGROUND: Praziquantel treatment of schistosomiasis during pregnancy was only recommended in 2002; hence the effects of treatment during pregnancy are not fully known. We have therefore evaluated the effects on infection intensity and the immunological effects of praziquantel treatment against Schistosoma mansoni during pregnancy, compared with treatment after delivery. METHODS: A nested cohort of 387 Schistosoma mansoni infected women was recruited within a larger trial of de-worming during pregnancy. Women were randomised to receive praziquantel or placebo during pregnancy. All women were treated after delivery. Infection intensity after treatment was assessed by a single Kato-Katz examination of stool samples with duplicate slides and categorised as undetected, light (1-99 eggs per gram (epg)), moderate (100-399 epg) or heavy (>or=400 epg). Antibodies against S. mansoni worm and egg antigens were measured by ELISA. Results were compared between women first treated during pregnancy and women first treated after delivery. RESULTS: At enrollment, 252 (65.1%) of the women had light infection (median (IQR) epg: 35 (11, 59)), 75 (19.3%) moderate (median (IQR) epg: 179(131, 227)) and 60 (15.5%) had heavy infection (median (IQR) epg: 749 (521, 1169)) with S. mansoni. At six weeks after praziquantel treatment during pregnancy S. mansoni infection was not detectable in 81.9% of the women and prevalence and intensity had decreased to 11.8% light, 4.7% moderate and 1.6% heavy a similar reduction when compared with those first treated after delivery (undetected (88.5%), light (10.6%), moderate (0.9%) and heavy (0%), p = 0.16). Parasite specific antibody levels were lower during pregnancy than after delivery. Praziquantel treatment during pregnancy boosted anti-worm IgG isotypes and to a lesser extent IgE, but these boosts were less pronounced than in women whose treatment was delayed until after delivery. Praziquantel had limited effects on antibodies against egg antigens. CONCLUSION: S mansoni antigen-specific antibody levels and praziquantel-induced boosts in antibody levels were broadly suppressed during pregnancy, but this was not associated with major reduction in the efficacy of praziquantel. Long-term implications of these findings in relation to resistance to re-infection remain to be explored

Real-time PCR Demonstrates Ancylostoma duodenale Is a Key Factor in the Etiology of Severe Anemia and Iron Deficiency in Malawian Pre-school Children

Hookworm infections are a major cause of childhood anemia and iron deficiency. Two hookworm species exist of which Ancylostoma duodenale is the less common, yet causing more blood loss than Necator americanus. Although species differentiation and quantification are both of clinical importance, these are often not performed as the technique is complex and laborious using microscopy. Multiplex real-time PCR is a novel diagnostic tool which allows hookworm species differentiation and infection quantification. We applied this test in 830 stool samples of Malawian children with and without severe anemia. The prevalence of hookworm infections was high. A. duodenale was unexpectedly more prevalent than N. americanus. A. duodenale infections were associated with increased risk for severe anemia and iron deficiency, both of which increased with infection load. The study identifies a need for the quantitative screening of species-specific hookworm infections, which readily can be achieved by real-time-PCR. A. duodenale was independently associated with severe anemia and iron deficiency in our study population

Evaluating the Skills Curriculum: Challenges and Opportunities for Law Schools

Law schools have compelling reasons to begin thoroughly reviewing their skills curriculum. Three new publications emphasize that preparing students for practice as competent and ethical lawyers is the central mission of legal education and scrutinize methods for achieving that goal. A new ABA Standard for Accreditation (the Standard or Standard 302 ), revised in 2005 to mandate skills education for every law student, is now being applied at law school reaccreditation reviews. In addition, Educating Lawyers: Preparation for the Profession of Law (the Carnegie Report ), a report written by the Carnegie Foundation for the Advancement of Teaching, and Best Practices for Legal Education ( Best Practices ), an analysis conducted by law professors, were both published in 2007 and distributed nationally. The Carnegie Report and Best Practices examine law school pedagogy throughout law school curriculums in light of the ambitious goal of preparing students for ethical and competent practice. Their thorough critiques of legal education should inspire law schools that review their curriculum for compliance with ABA Standards to expand their effort and promote excellence in skills education. ... In light of these developments, this Article suggests how a law school can use the review of its skills curriculum implicated by Standard 302 to understand and strengthen its ability to develop the professional skills of its students. This Article focuses on principal areas of information to investigate when evaluating skills education and on specific challenges in conducting that review. The Article also comments on initial efforts of this type at Rutgers University School of Law- Camden. Part II of this Article considers how key requirements of the Standard can be understood expansively in light of the ambitious goals of skills education embodied in both the Carnegie Report and Best Practices. Part III continues in that spirit, going beyond the ABA Standards to identify additional teaching practices and curriculum structure with important links to effective skills education. Part IV addresses the challenging task of understanding attainable pedagogical goals for skills education in its various forms. Part V identifies the principal tasks and challenges in evaluating a skills curriculum. Finally, the Article suggests that evaluating skills curriculum yields worthwhile outcomes, such as communication among all faculty members about goals and methods, more comprehensive options for students, and development of standards for the ongoing process of improving the program of skills education

Collaboration and Modeling: Reconsidering Non-Directive Orthodoxy in Clinical Legal Education

Clinical legal education scholarship has primarily emphasized “nondirective” supervision of law students by lawyer supervisors, although some scholars have contended that other supervision methods may be helpful for some students and a few have contended that the method of supervision was not critical to student learning. Externship supervision provides examples of a varied repertoire of supervision methods that may be applicable to on-campus clinics as well, depending on the educational goals of the clinic. Student views of the teaching value of supervision they experienced in externship at the author’s law school support the view that collaboration and modeling, as well as nondirective supervision, are effective at helping students assume and understand their professional roles as lawyers

Towards a New World of Externships: Introduction to Papers from Externships 4 and 5

The scholarly literature on externships is growing and deepening, addressing concerns of importance to field placement programs and to clinicians in general. This Introduction places the issues raised by the subsequent four articles on externships into the context of current national debates about the externship method. These issues, which both extend and diverge from current thinking about externship pedagogy, include: 1) the impact of a harsh economic climate; 2) the educational potential of placements in corporate counsel offices; 3) the argument for compensating students in for-credit placements; and 4) the value of course design for teaching power dynamics in supervisory relationships. Taken together, the issues explored in these four articles point toward a new world of externships, filled with both opportunity and risk for clinical education. This new world poses key questions, not just for externships, but for clinical legal education and legal education generally

Impact of Anthelminthic Treatment in Pregnancy and Childhood on Immunisations, Infections and Eczema in Childhood:A Randomised Controlled Trial

Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects.A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda [ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly single-dose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15–2.17), p = 0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73–0.98), p = 0.03). There were no consistent effects of the interventions on any other outcome.Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries. By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control where helminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct.Current Controlled Trials ISRCTN3284944